CLIENT NAIL CARE INTAKE FORM

    Click to Upload Photo

    Disclaimer: Thank you for your interest in being a client of
    Information collected about new clients is confidential and will be treated accordingly.

    CLIENT INFORMATION


    YOUR NAILS & HANDS

    SplitPeelCrackBreak

    DryTornRaggedInflamed/Red

    YesNo

    Open WoundsCutsBruisesTendernessRash/Irritation

    YOUR HEALTH


    YesNo


    DiabetesHepatitisHIV/AIDSOther


    YesNo

    READ & ACCEPT

    By signing below, you attest that you have provided accurate and current information on this form and answered all medical and health-related questions truthfully and completely. Your signature also certifies that you understand that the above-named salon reserves the right to deny service to any client due to a health condition he or she has that may pose a potential risk to practitioners or other clients, including those that pose a risk of potential contamination to service areas. Furthermore, signing below verifies that you understand that you are responsible for informing the above-named salon or its manicure and pedicure technicians of ANY and ALL changes to your health condition as regards any question on this form or any potential public health risk that may arise from any change in your health condition. You acknowledge and accept that withholding information or providing misinformation may result in contraindications or irritation to the nails and skin from treatments received. The treatments you receive here are voluntary and you release this nail care professional and the above-named salon from liability and you assume full responsibility thereof.

    CLIENT SIGNATURE